We have an opportunity to join the Alliance as the Provider Payment Strategy Manager in the Payment Strategy Department.
WHAT YOU'LL BE RESPONSIBLE FOR
- Managing the advancement of provider reimbursement methodologies to align with organizational strategies and objectives, including value-based payment, and advising executive leadership regarding the feasibility of various strategies and methodologies
- Utilizing a variety of methods and models to evaluate the feasibility of reimbursement methodologies
- Providing management oversight and guidance related to the provider reimbursement function, acting as a subject matter expert, and providing guidance on departmental operations
- Managing, supervising, mentoring and training assigned staff
ABOUT THE TEAM
We ensure the Alliance's stewardship of appropriate use of public funds through recoveries, coordination of benefits, contract negotiations and insurance.
WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here.
- Knowledge of:
- Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
- Provider contracting, including language, reimbursement methods, and rates
- Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical and provider data
- Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), ICD 9/10 and CPT codes, and industry standard groupers, such as ETGs, DRGs, and DCGs
- General health service research, healthcare analytics and analysis, outcomes reporting/analytics, and program outcomes evaluation
- Ability to:
- Develop work plans and workflows and organize and prioritize provider reimbursement activities
- Train, mentor, supervise, and evaluate the work of staff, promote an atmosphere of teamwork and cooperation, and motivate staff to achieve goals and objectives
- Negotiate value-based provider reimbursement rates and assist with the development of related contract language
- Apply analytical and pricing expertise to the evaluation, negotiation, implementation, and maintenance of managed care contracts
- Education and Experience:
- Bachelor’s degree in Finance, Economics, Accounting, Health Care or a related field
- A minimum of six years of experience performing provider reimbursement activities and/or provider payment strategy activities, including a minimum of two years of experience in a managed care environment, and a minimum of two years of management, supervisory, or lead experience; (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
OTHER DETAILS
- While this position is connected to one of our Alliance offices, we are in hybrid remote/in-office work environment right now and we anticipate that the interview process will take place remotely.
- Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
- Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.
The full compensation range for this position is listed by location below.
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
OUR BENEFITS
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 12 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- Onsite EV Charging Stations
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.
